History of cesarean before 32 weeks' gestation and trial of labor: what is the risk of uterine rupture?
OBJECTIVE
To estimate the risk of uterine rupture in women with a previous cesarean delivery before 32 weeks' gestation and a trial of labor.


METHODS
Retrospective case control study. Setting. Level III maternity center.


METHODS
Among women with trial of labor, the case and control groups were women with previous cesarean section before and after 32 weeks, respectively. The main outcome was uterine rupture, defined as rupture of the three layers of the uterine wall.


RESULTS
The study compared 108 trials of labor in patients with a previous cesarean delivery at a mean gestation of 29.8 weeks+/-2.0 SD and 137 trials of labor in patients with a previous cesarean delivery at a mean gestation of 39.2 weeks+/-2.3 SD. Mode of delivery did not differ between groups. Two uterine ruptures (1.9%, 95% CI: 0.0-4.4) occurred in the case group and none in the control group (p=0.16). Uterine ruptures caused no serious maternal or neonatal complications. The condition of the neonates was similar in the two groups.


CONCLUSIONS
In view of the small number of uterine ruptures and the absence of severe maternal and fetal consequences over an 8-year period, a trial of labor may be proposed to women with a history of cesarean delivery before 32 weeks, when obstetrical conditions are optimal.
Estrade
Sonia
S
Maternité Port-Royal, Hôpital Cochin Saint-Vincent-de-Paul, Assistance Publique-Hôpitaux de Paris, Paris, France.
Schmitz
Thomas
T
Cabrol
Dominique
D
Huchon
Cyrille
C
Goffinet
Francois
F
D000328:Adult; D016022:Case-Control Studies; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D018570:Risk Assessment; D014219:Trial of Labor; D014597:Uterine Rupture / Q000209:etiology*